• Medical Claim Review

    Molina Healthcare (Salt Lake City, UT)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Salt Lake City, UT)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
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  • Initial Review Pharmacy Technician

    Prime Therapeutics (Salt Lake City, UT)
    …staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when ... more
    Prime Therapeutics (02/12/25)
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  • Payment Integrity Clinician - RN (Remote)

    Highmark Health (Salt Lake City, UT)
    review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... more
    Highmark Health (02/13/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Salt Lake City, UT)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Salt Lake City, UT)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/06/25)
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  • Clinical Coding Appeals Supervisor

    R1 RCM (Salt Lake City, UT)
    …prior leadership experience in medical record reviews and extensive knowledge of medical coding for inpatient and outpatient claims , as well as reimbursement ... more
    R1 RCM (02/15/25)
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  • Special Investigation Unit Manager Clinical…

    CVS Health (Salt Lake City, UT)
    …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... more
    CVS Health (12/25/24)
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